Moses New-Aaron, Jane L. Meza, Martha Goedert, Stephen Kibusi, Samwel Sumba, Caroline Damien, Siraj Shabani, and James Charles
Cervical cancer is the most common cancer worldwide with increased risk among women living with HIV in a resource limited environment. Hence the need to determine factors affecting awareness, prior uptake of cervical cancer screening and willingness to screen among patients receiving Antiretroviral (ARV) drugs.
The data was collected by administered questionnaires to patients presenting for monthly ARV refills in a HIV clinic in Dodoma, Tanzania. A total of 421 women in the clinic with an average monthly income of 39 (USD) were interviewed. A total of 306 (73%) were aware of cervical cancer. Among those who were aware, 84 % (257) did not recall been screened for cervical cancer. A total of 231 (90%) expressed willingness to be screened among patients who have never screened for cervical cancer. The average years since HIV infection for the subjects was 5.4 years; average age was 44. A logistic regression model was used to examine factors associated with awareness of cervical cancer, prior uptake of screening and willingness to be screened. Urban dwellers were found to have higher odds of awareness than rural dwellers (OR: 3.68 95% CI: 2.12-6.38). Prior uptake of screening was found higher among urban vs. rural dwellers, OR: 3.43, 95% CI: 1.02-11.51. The willingness to be screened decreased with age (OR: 0.93, 95% CI: 0.88-0.97).
This study have indicated the problem of access among rural dwellers to cervical cancer screening. Willingness to screen among younger patients could be due to increased awareness of the disease among younger patients than older patients. However, the older and rural patients are at higher risk of cervical cancer and should be targeted for primary prevention.
Advocacy and Health Policy
Effect of Nitrosamine (NNAT) on Embryogenesis: Evidence from a Study Using Avian Embryos Exposed to NNAT
Moses New-Aaron, Martha Rhoades, Jane L. Meza, and Jeffrey Wallman
Birth defects are a known cause of infant death in the United States with higher rates in the Midwest perhaps due to higher use of agrichemicals for farm activities. Nitrate and atrazine are two of the most prevalent agrichemicals contaminating drinking water supplies. When ingested together, in the acidic environment of the human stomach, they can react to form a nitrosamine, NNAT. Many nitrosamines are known to be mutagenic, carcinogenic and teratogenic.
Preliminary studies have suggested that NNAT is a teratogen and mutagen. Several other agrichemical compounds have been detected in Nebraska groundwater wells that have the potential to nitrosate and studies are underway to evaluate the risk of adverse birth outcomes associated with exposure to these compounds. In this study, we evaluated growth in chick embryos after exposure to NNAT.
We hypothesize that the embryo exposed to NNAT would have delayed development compared to unexposed embryos.
Three groups of eggs were observed in the study: the treatment group was treated with different doses of NNAT dissolved in Dimethyl sulfoxide (DMSO), the vehicle control group were treated with only DMSO and the untreated group (control). The air sac of the treatment groups was injected with varying concentrations of NNAT at one time to stimulate an acute response and at different times for a chronic response.
All analysis was done on SAS 9.4. The effect of treatments on the weight and survival of the embryos were determined using analysis of covariance (ANCOVA) and multiple logistic regression respectively. The effect of treatment was found to be significant on the embryo treated with NNAT after adjusting for the effect of the positions of the eggs during incubation (p<0.0001). Embryos that were untreated (controls) had the highest weight (weight=0.34g), and as the dose of NNAT was increased during treatment the weight of the embryo decreased significantly after incubation for 5 days : 0.245 µmol/l of NNAT (weight=0.15g, p=0.0009), 1.11 µmol/l of NNAT (weight=0.13g, p=0.004), 2.22 µmol/l of NNAT (weight=0.11g, p=0.01) and 3.33 µmol/l of NNAT (weight=0.12g, p=0.01). Also, it was found that the odds of survival among the embryo decreased linearly with increased dose when treated with NNAT as compared to the untreated embryos: 1.11 µmol/l of NNAT vs untreated (OR=0.250 95% C.I. 0.078-0.799), 2.22 µmol/l of NNAT vs. untreated (OR=0.120 95% C.I. 0.042-0.347) and 3.33 µmol/l of NNAT vs untreated (OR=0.106 95% C.I. 0.036-0.311)
This study has revealed that weight and odds of survival of embryo exposed to NNAT decreased after 5 days of incubation. Dose-effect of the treatment was also observed during the development of embryos exposed to NNAT. Additional studies, however, is needed to evaluate the toxic effects of DMSO on the chick’s embryo before a conclusion can be reached.
Sonja F. Tutsch, Patrick Fowler, Gaurav Kumar, Adam Weaver, Brian McKevitt, Denise Britigan, Christian I.J. Minter, and Lorena Baccaglini
Implications of anxiety symptomatology experienced among children and adolescents in the US constitute a major public health crisis, calling for promising universal mental health interventions in K-12 schools. Schools represent an ideal setting for the implementation of population based, public health interventions, as children and adolescents spend a significant proportion of time in school. Discussions within the scientific community document several advantages to utilization of universal, Tier1 interventions. However, the efficacy of universal, school-based anxiety interventions in the US are not consistently documented. The purpose of this study is to systematically review the literature to identify the efficacy of universal teacher-led school-based anxiety interventions in the US. A comprehensive literature search was conducted employing PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO, Education Resources Information Center (ERIC), and Google Scholar databases up to December 2016. Each of the articles was independently reviewed for relevance and inclusionary criteria, with five studies meeting these criteria. Overall, the quality of the included studies was moderate. All reviewed studies found that universal teacher-led anxiety interventions in school-based programs had a positive impact on the anxiety outcomes of students when compared to control groups. However, several methodological and design concerns were identified across studies. While our findings suggest that universal teacher-led anxiety interventions have the potential to reduce anxiety symptomatology among school-aged children in the US, further research is needed.
Kandy Do, Drissa Toure, Naw Latt Nlam, and Dejun Su
Refugees resettling to Nebraska undeniably have different health needs compared to native Nebraska residents. Capturing those differences is the start to catering local health care to refugees. A health needs assessment of refugees in Omaha, Nebraska seek to assess their perceived needs, barriers, and preferences regarding health care, in order to address them justly. The refugee population in Omaha, Nebraska has exponentially increased over the past decade and will continue to increase, bringing global health matters to our backyard. The data and results from surveying over 290 refugees will guide health care organizations and services to appropriately serve refugees and their specific needs.
Moses New-Aaron, Jane L. Meza, Martha Goedert, Stephen Kibusi, James Charles, Caroline Damien, Samwel Sumba, and Siraji Shabani
High risk sexual practices among people living with HIV is a crucial public health issue due to increasing HIV incidence. This study describes factors that could be attributed to risky sexual behaviors among people living with HIV
Self-reported patient characteristics were collected using a mobile-based data collection method from the HIV clinic in Dodoma, Tanzania. Risky sexual behavior was defined by the patient's use of condoms during sexual intercourse. SAS 9.4 was used for all statistical analysis. Test of association was conducted between the use of condom and the patient's characteristics using a univariate analysis. Significant associations were determined at p<0.05. Multivariate analysis was further conducted to determine the factors that impacted risky sexual behavior among the study population.
561 patients were interviewed in the HIV clinic with an average income per month of 126,000tsh (57USD). 56% (315) were sexually active of which 82% (257) used condoms during sexual intercourse. 76% (44) of the patients who do not use condoms earned less than 120,000tsh (54USD) and 83% (48) of the patients who did not use condoms were urban dwellers. 26% (15) of non-condom users reported more than 1 sexual partner and 33% (19) of the non-condom users had their first sexual intercourse at age less than 18 years. In a multiple logistic regression, condom use was 5.5 times more likely in patients who had HIV for 6-9 years when compared to patients who have had HIV for less than 3 years (95% C.I. 1.8-17.0). Homemakers living with HIV were less likely to use condoms when compared to regular workers (OR=0.0065, 95% CI: 0.01-0.6).
The dangers of risky sexual behaviors based on condom use are perceived more in patients who were recently diagnosed. The conditions surrounding the non-use of condoms in HIV positive patients deserves a more global approach, including understanding access to condoms, the availability and cost on set incomes, and the power imbalances that may be at play for women without a regular job beyond access issues and this should be considered for future studies. Also, the early age of first intercourse may be best collected by determining if this was an early childhood sexual abuse with life-long exposure, or later teen onset up to the age of 18 years in order to understand the characteristics of patients who had their first sexual intercourse at age less than 18 years old.
The Determinants of Cervical Cancer Screening Among Patients Receiving ARVs in a Resource-Limited Environment
Moses New-Aaron, Jane L. Meza, Martha Goedert, Stephen Kibusi, James Charles, Caroline Damien, Samwel Sumba, and Siraji Shanbani
Cervical cancer is the most common cancer worldwide with increased risk among women living with HIV in a resource limited environment. This study aimed to describe rates and determinants of cervical cancer screening among patients receiving Antiretroviral (ARV) drugs.
The data was collected by administered questionnaires to patients presenting for monthly ARV refills in an HIV Clinic in Dodoma, Tanzania.
A total of 421 women presenting for monthly ARV refills at the Regional Referral HIV Clinic in Dodoma, Tanzania was interviewed, of which 90% (375) had never heard of HPV and only 1% (4) had received the HPV vaccine. The average duration of HIV infection was 5.43years. While 87% (367) of the women had never been screened for cervical cancer, 12.5% (46) were not willing to undergo screening. Uptake of cervical cancer screening and the willingness to screen were modeled in multiple logistic regression models to exam factors impacting screening. Duration of HIV infection was not significant in the model but was linearly associated with the cervical cancer screening (p=0.02) in Mante-Haenszel Chi-Square. Women without any live children were 2.6 (95% C.I 1.2-5.6) times less likely to screen for cervical cancer than women with 1-2 live births and rural dwellers were 3.0 (95% C.I 1.1-8.1) times less likely to screen than urban dwellers. Women age 40-49 years were 5.0(95% C.I. 1.6-15.3) times not willing to screen for cervical cancer than women of age group 18-39 years.
It is recommended that more education on cervical cancer screening should be provided for rural dwellers, older or middle aged women, and women without children. Increasing rates of cervical cancer screening for immune-compromised, along with HPV vaccine campaigns to increase knowledge and vaccination rates are preventive strategies targeting invasive cervical cancer.
Moses New-Aaron, Martha Rhoades, Jane L. Meza, and Jeff Wallman
Evidences that agrichemicals might be associated with the incidence of birth defects are inconsistent.
- Examine whether Triazine, Acetanilide, Carbamothioate, Nitrate, Trifluralin and Uracil present in well-water are associated with birth defect rates in Nebraska Counties
- Identify the well types contaminated with these pesticides.
Birth defects data obtained from Nebraska Department of Human and Health Services were merged with data on wells tested for agrichemicals obtained from Quality-Assessed Agrichemical Contaminant Database for Nebraska Ground Water. The 33 contaminants sampled from the wells were sub classified into 6 predictors and expressed as percentages for analysis in a multiple regression model with birth defect rates as the response variable. The pesticides sampled from the wells were also categorized into parent and degradate to examine the nature of pesticide associated with birth defects. Due to multicollinearity, triazine, acetanilide and trifluralin were summed together.
The percentage for triazine and nitrate in domestic wells were 10.6% and 21.5% respectively. Birth defect rates were discovered to correlate with triazine (r= 0.21 p=0.041). triazine- acetanilide-trifluralin together was found to be linearly associated with birth defect rates in the multiple linear regression model (p=0.012). A stronger correlation was found between the parent contaminants and birth defect rates(r=0.22 p=0.034) than the degradate. (r=0.15 p=0.163).
This study suggests an association between birth defect and percent of wells positive for agrichemical compounds. However, this association does not imply causation but provides direction for future investigation.
Comparison of Agricultural Injury and Fatality Characteristics Obtained from Media Monitoring Versus Official Statistics
Moses New-Aaron, Jessica Semin, Risto Rautiainen, and Murray Madsen
Objective of project:
1. Compare the characteristics of fatal injuries reported by CFOI and CS-CASH media monitoring
2. Analyze the agreement between CFOI reported injuries and CS-CASH media monitoring fatal injuries
The Bureau of Labor Statistics, Census of Fatal Occupational Injuries (CFOI) provides statistics on occupational fatalities, but information on individual cases is not reported. The Central States Center for Agricultural Safety and Health (CS-CASH) tracks media reports of agricultural injury and fatality cases to augment CFOI data.
Data was obtained from variety of sources. The primary data source was "Google Alerts" and other sources includes press clippings and local media reports. The key words used for selecting relevant articles were “farm accident”, “farm incident”, “farm death”, “ranch accident”, “ranch death” and “livestock. All agricultural related incidents occurring in Nebraska, Iowa, Minnesota, South Dakota, North Dakota, Missouri and Kansas between 2012-June 2016 were selected for analysis. Data was obtained from CFOI database for different type of injury events and compared to those obtained from different media sources using 2 independent t test. An association between fatalities or farm injuries and other characteristics was determined in a using a Pearson Chi square and a multivariate analysis using a multiple logistic regression model.
We found significant differences in CS-CASH media monitoring data between fatal and non-fatal injuries. Google alerts included a higher proportion of roadway incidents, …, …, and … compared to data from press clips from print media. CFOI data included a higher proportion of …, …., and … fatalities compared to data from CS-CASH media monitoring.We found significant differences in CS-CASH media monitoring data between fatal and non-fatal injuries (p<0.0001). CFOI data included a higher proportion of injuries from struck, contact and fall when compared to CS-CASH media monitoring data. However, there is no significant difference between the CFOI data and the CS-CASH media monitoring of fatal injury data for “caught” (p=0.094)
This study suggests an agreement between CFOI data and media monitoring data for fatal injury events due to being caught in running equipment.
Moses New-Aaron, Jessica Semin, Risto Rautiainen, and Murray Madsen
Background: Studying the work environment and demographics of agricultural workers involved in fatal incidents can provide valuable information on the cause of fatalities and lead to better prevention measures.
Objectives: To determine populations at risk of fatalities and the determinants of fatalities in production agriculture.
Method: Agricultural injury and fatality data were obtained from Press clippings and Google alerts covering seven Midwest States (SD, ND, MN, IA, NE, KS and MO). Google Alerts were collected based on key words including: “farm accident”, “farm incident”, “farm death”, “ranch accident”, ”ranch incident”, “ranch death”, “ATV farm death”, “ATV ranch death”, “livestock death”, as well as other descriptors. Articles from Google Alerts were screened. Relevant articles were analyzed, and data were then extracted and added to the database. Differences in demographic and characteristics between fatal and non-fatal injuries were compared within the CS-CASH media monitoring database using the chi-square and logistic regression model.
Results: A total of 1048 agricultural-related injuries including 586(56%) non-fatal cases and 462 (54.16%) fatalities were collected between 2011 to 2017 across the seven Midwest states by CSCASH monitoring database. We found that fatality was significantly associated with; age group (p<0.0001), type of injury event (p<0.0001), source of injury (p=0.01), time of injury (p=0.0018), activities during injury (p=0.0002), place of injury (p<0.0001) and gender (p=0.0004) in a univariate analysis. It was further discovered in a multiple logistic regression that age groups, time and the place of injury were good predictors of fatalities.
Conclusion: This study suggests that place of injury, time of injury and age of the victims were possible determinants of fatalities and males, elderly and the infants had more fatalities in agricultural production industry.
Abby Wolfe, Anh Nguyen, Ashleigh Galles, Madison Wolfe, and Ben Lundberg
A poster from the UNMC Undergraduate Public Health Workshop
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